Older Adults' Views on Social Interactions and Online Socializing Games - A Qualitative Study.

Age-related difficulties and quarantine restrictions impede the possibilities to maintain contact with one's social network. Maintaining these contacts may be supported by digital games. To develop effective and feasible digital tools to foster social interaction, we aimed to explore what older adults find important in social contact and what barriers and enablers they foresee in digital gaming interventions as network support aids. Two focus groups and 20 semi-structured interviews (N = 29) with older adults (aged 55-87) were held to explore the research questions. Furthermore, a questionnaire was administered (N = 29) containing measures of loneliness, frailty, and social network size. Participants found 'reciprocity', 'in-person contact', and 'personal connection' important in contact with strong ties. Online games were not used much for socializing but may be used in the future, particularly by less mobile older adults. Future social gaming interventions should be challenging, user-friendly, and offer the possibility to communicate. Digital co-designed interventions that are feasible, challenging, intuitive, and trigger meaningful communication may strengthen social interactions in older adults. They may be a relevant social support tool in periods of interaction limitations due to functional impairment or social isolation.

Comparing ActiGraph equations for estimating energy expenditure in older adults.

Accurate estimation of energy expenditure (EE) from accelerometer outputs remains a challenge in older adults. The aim of this study was to validate different ActiGraph (AG) equations for predicting EE in older adults. Forty older adults (age = 77.4 ± 8.1 yrs) completed a set of household/gardening activities in their residence, while wearing an AG at the hip (GT3X+) and a portable calorimeter (MetaMax 3B - criterion). Predicted EEs from AG were calculated using five equations (Freedson, refined Crouter, Sasaki and Santos-Lozano (vertical-axis, vectormagnitude)). Accuracy of equations was assessed using root-mean-square error (RMSE) and mean bias. The Sasaki equation showed the lowest RMSE for all activities (0.47 METs) and across physical activity intensities (PAIs) (range 0.18-0.48 METs). The Freedson and Santos-Lozano equations tended to overestimate EE for sedentary activities (range: 0.48 to 0.97 METs), while EEs for moderate-to-vigorous activities (MVPA) were underestimated (range: -1.02 to -0.64 METs). The refined Crouter and Sasaki equations showed no systematic bias, but they respectively overestimated and underestimated EE across PAIs. In conclusion, none of the equations was completely accurate for predicting EE across the range of PAIs. However, the refined Crouter and Sasaki equations showed better overall accuracy and precision when compared with the other methods.

The World report on ageing and health: a policy framework for healthy ageing.

Although populations around the world are rapidly ageing, evidence that increasing longevity is being accompanied by an extended period of good health is scarce. A coherent and focused public health response that spans multiple sectors and stakeholders is urgently needed. To guide this global response, WHO has released the first World report on ageing and health, reviewing current knowledge and gaps and providing a public health framework for action. The report is built around a redefinition of healthy ageing that centres on the notion of functional ability: the combination of the intrinsic capacity of the individual, relevant environmental characteristics, and the interactions between the individual and these characteristics. This Health Policy highlights key findings and recommendations from the report.

The influence of long-term exposure and timing of physical activity on new joint pain and stiffness in mid-age women.

OBJECTIVE: To examine the influence of long-term exposure and timing of physical activity (PA) on new joint pain/stiffness in mid-age women. METHODS: Data were from 5105 participants (born 1946-51) in the Australian Longitudinal Study on Women's Health (ALSWH) who completed survey items on PA (1998, 2001 and 2004) and joint pain/stiffness (2007 and 2010). PA was categorized in five levels at each survey and summed into a cumulative PA score (CPA, range 0-12). Associations were analysed using logistic regression, with separate models for the cumulative model (using CPA), the sensitive periods model (i.e., PA measured at each survey in one regression model) and the critical periods model (i.e., separate regression models for PA at each survey). RESULTS: 951 (18.6%) participants reported new-onset joint pain/stiffness. In the cumulative model, CPA was associated joint pain/stiffness when included as a continuous variable (adjusted odds ratio [OR] = 0.97, 95% confidence interval [CI] = 0.95-0.99), but not when included as a categorical variable. In both the sensitive periods and critical periods models, low to high levels of PA in 2001 and 2004 had stronger inverse associations with joint pain/stiffness than PA levels in 1998. The model fit was better for the sensitive periods than the cumulative or critical periods models. CONCLUSIONS: In mid-age women, PA between the ages 47 and 58 was associated with a lower risk of joint pain/stiffness 9 years later. Associations were stronger for PA in the last 6 years than for earlier PA.

Actions following adverse drug events - how do these influence uptake and utilisation of newer and/or similar medications?

BACKGROUND: Over the last decade, actions following some adverse drug events received major publicity. This study investigated changes in usage patterns of medications in Australia following two examples - rofecoxib market withdrawal (2004) and warnings about jaw necrosis following bisphosphonates (2007). METHODS: Dispensing data for COX-2 inhibitors (2000-2008) and anti-osteoporosis medications (2003-2012) were obtained from the Australian Pharmaceutical Benefits Scheme database. For bisphosphonates, data on Australian marketing expenditures were purchased from Cegedim(R). RESULTS: For COX-2 inhibitors, celecoxib dispensing halved after rofecoxib withdrawal, but meloxicam dispensing increased by 60 %. When lumiracoxib was introduced (2006) there was uptake of prescribing at a faster rate than meloxicam in 2002, its first year of use. For bisphosphonates, alendronate had highest use at the time of the warnings (8.3 DDD/1000/day), dropping to 4.9 DDD/1000/day by 2012. In contrast, risedronate use rose 2007-2012 from 4.1 to 4.9 DDD/1000/day. There was 49 % increase in reported annual expenditure on detailing for risedronate from 2007 to 2008 (to AUD$7.3 million) and only 29 % increase for alendronate (to AUD$3.1 million). CONCLUSIONS: The rapid uptake of prescribing of lumiracoxib and increased use of meloxicam flagged a concern, especially after rofecoxib withdrawal due to safety issues. Bisphosphonates are useful drugs, however the dramatic rise in expenditure on detailing, followed by a rise in utilisation of risedronate could suggest that adverse publicity triggered a marketing response. These examples highlight the importance of tracking utilisation of medication classes in real time, using different data as needed, to ensure that due caution is exercised (and quick intervention provided if needed) for medications in the same class.

Lifestyle behaviour changes associated with osteoarthritis: a prospective cohort study.

The aim of this prospective cohort study was to compare changes in lifestyle behaviours over nine years in women who were and were not diagnosed with osteoarthritis (OA). Data were from the 1945-51 cohort of the Australian Longitudinal Study on Women's Health (aged 50-55 in 2001) who completed written surveys in 2001, 2004, 2007 and 2010. The sample included 610 women who were, and 3810 women who were not diagnosed with OA between 2004 and 2007. Descriptive statistics were used to assess changes in lifestyle behaviours (weight, sitting time, physical activity, alcohol and smoking) in the two groups, over three survey intervals: from 2001-2004 (prior to diagnosis); from 2004-2007 (around diagnosis); and from 2007-2010 (following diagnosis). Compared with women without OA (28%), a greater proportion of women with OA (38%) made at least one positive lifestyle change (p < 0.001). These included losing > 5 kg (9.8% vs. 14.4%, p < 0.001), and reducing sitting time by an hour (29.5% vs. 39.1%, p < 0.001) following diagnosis. However, women with OA also made negative lifestyle changes (35% vs. 29%, p < 0.001), for example, gaining > 5 kg around the time of diagnosis (21.4% vs. 14.5%, p < 0.001) and increasing sitting time by an hour following diagnosis (38.4% vs. 32.3%, p = 0.003). More women with OA also started smoking following diagnosis (8.9% vs. 0.8%, p < 0.001). While some women made positive changes in lifestyle behaviours during and following OA diagnosis, others made negative changes. Consistent support from clinicians for managing OA symptoms may enable patients to make more positive changes in lifestyle behaviours.

Associations between sitting time and a range of symptoms in mid-age women.

OBJECTIVE: The aim of this study was to explore longitudinal associations between sitting and physical and psychological symptoms in mid-age women. METHOD: Mid-age (53-58 years) participants in the Australian Longitudinal Study on Women's Health completed mail surveys in 2004 (n=10,286), 2007 (n=10,128) and 2010 (n=9452) with questions about sitting time (<6, 6-9, and ≥ 9 h/day) and frequency of 19 symptoms in the preceding 12 months (often vs. never/rarely/sometimes). Associations between sitting and symptoms were examined using two logistic generalized estimating equations models: (a) sequential cross-sectional data from 3 surveys, and (b) prospective model with a 3-year time lag (significance level=0.01). RESULTS: Approximately 53%, 30% and 17% of the women were classified as sitting <6, 6-9 and ≥ 9 h/day in 2004. In adjusted cross-sectional models, women sitting ≥ 9 h/day had significantly higher odds of breathing difficulties (OR=1.52, 99% CI=1.17-2.00), tiredness (OR=1.21, CI=1.05-1.40), bowel problems (OR=1.26, CI=1.02-1.56), eyesight problems (OR=1.16, CI=1.01-1.34), and depression (OR=1.39, CI=1.15-1.68) than women sitting <6h/day. Adjusted prospective models showed higher odds of breathing difficulties (OR=1.94, CI=1.40-2.69), chest pain (OR=2.04, CI=1.14-3.70), and tiredness (OR=1.24, CI=1.04-1.48). Associations with breathing difficulties and chest pain remained significant after excluding participants with chronic conditions in 2004. CONCLUSION: Prolonged sitting may a determinant of breathing difficulties and chest pain three years later in mid-age women.

The psychosocial adaptability of independently living older adults to COVID-19 related social isolation in the Netherlands: A qualitative study.

Since coronavirus disease 2019 (COVID-19) entered the Netherlands, the older adults (aged 70 or above) were recommended to isolate themselves, resulting in less social contact and possibly increased loneliness. The aim of this qualitative study was to explore independently living older adults' perceptions of social and emotional well-being during the COVID-19-related self-isolation, and their motivation to expand their social network in the future. Semi-structured phone interviews were held with 20 community-dwelling adults (age range 56-87; 55% female) between April and June 2020 in the Netherlands. The interviews were audio recorded and transcribed verbatim. Open coding process was applied to identify categories and themes. Participants said to use more digital technologies to maintain contacts and adapt to the government measurements. Most participants missed the lack of social contacts, while some participants had no problems with the reduced social contacts. The emotional well-being of most participants did not change. Some participants felt unpleasant or mentioned that the mood of other people had changed. Participants were not motivated to expand their social network because of existing strong networks. The relatively vital community-dwelling older adults in this study were able to adapt to the government recommendations for self-isolation with limited negative impact on their socio-emotional well-being.

Population Attributable Fractions for Modifiable Risk Factors of Incident Dementia in Cognitively Normal and Mild Cognitively Impaired Older Adults: Data from Two Cohort Studies.

BACKGROUND: Recent global meta-analyses show that 40% of dementia cases can be attributed to twelve modifiable risk factors. OBJECTIVE: To investigate how health promotion strategies may differ in specific populations, this study estimated population attributable fractions (PAFs) of these risk factors for dementia in cognitively normal (CN) individuals and individuals with mild cognitive impairment (MCI) in United States and Greek cohorts. METHODS: We re-analyzed data from the National Alzheimer's Coordinating Centre (NACC, n = 16,147, mean age 75.2±6.9 years, 59.0% female) and the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD, n = 1,141, mean age 72.9±5.0 years, 58.0% female). PAFs for the total samples and CN and MCI subgroups were calculated based on hazard ratios for the risk of dementia and risk factor prevalence in NACC (9 risk factors) and HELIAD (10 risk factors). RESULTS: In NACC, 2,630 participants developed MCI (25.1%) and 3,333 developed dementia (20.7%) during a mean follow-up of 4.9±3.5 years. Weighted overall PAFs were 19.4% in the total sample, 15.9% in the CN subgroup, and 3.3% in the MCI subgroup. In HELIAD, 131 participants developed MCI (11.2%) and 68 developed dementia (5.9%) during an average follow-up of 3.1±0.86 years. Weighted overall PAFs were 65.5% in the total sample, 65.8% in the CN subgroup and 64.6% in the MCI subgroup. CONCLUSION: Translation of global meta-analysis data on modifiable risk factors should be carefully carried out per population. The PAFs of risk factors differ substantially across populations, directing health policy making to tailored risk factor modification plans.

Metabolic Equivalent Values of Common Daily Activities in Middle-Age and Older Adults in Free-Living Environments: A Pilot Study.

BACKGROUND: The purpose was to assess metabolic equivalent (MET) values of common daily activities in middle-age and older adults in free-living environments and compare these with MET values listed in the compendium of physical activities (CPA). METHODS: Sixty participants (mean age = 71.5, SD = 10.8) completed a semistructured protocol of sitting, lying, self-paced walking, and 4 self-selected activities in their residences. Oxygen consumption was measured using portable indirect calorimetry, to assess METs for each activity relative to VO2 at rest (VO2 during activity/VO2 at rest). Measured MET values for 20 different activities were compared with those in the CPA, for the total sample and for participants aged 55-64, 65-74, and 75-99 years. RESULTS: Measured METs for sitting, walking, sweeping, trimming, and laundry were significantly different from the CPA values. Measured MET values for sedentary activities were lower in all age groups, and those for walking and household activities were higher in the youngest age group, than the CPA values. For gardening activities, there was a significant decline in measured METs with age. CONCLUSIONS: Some measured MET values in older people differed from those in the CPA. The values reported here may be useful for future research with younger, middle-age, and older-old people.

Fall Risk Factors in Mid-Age Women: The Australian Longitudinal Study on Women's Health.

INTRODUCTION: In contrast to older adults, little is known about risk factors for falls in adults aged 50-64 years, despite a high prevalence of falls in this age group. The aim was to identify risk factors for falls in mid-age women and explore how associations change with age. METHODS: Data were analyzed in 2016 from women aged 50-55 years in 2001 (born 1946-1951) in the Australian Longitudinal Study on Women's Health. The predictor variables were health-related factors (measured 2001, 2004, 2007, 2010) and the outcome was falls in the past 12 months (measured 2004, 2007, 2010, 2013). Prospective associations between predictor variables and falls measured 3 years later were analyzed using logistic regression with complete data for 4,629, 7,096, 5,911, and 5,774 participants. RESULTS: In surveys, 20.5% (2004), 30.7% (2007), 30.5% (2010), and 26.6% (2013) of women reported a fall in the previous 12 months. In the univariable models, most factors were associated with falls 3 years later. In the multivariable models, higher odds of falling were found for overweight and obese women compared with healthy weight women at all survey intervals (OR range, 1.15-1.43). Impaired vision (OR range, 1.25-1.35) and poor physical functioning (OR range, 1.24-1.66) were associated with falls at three survey intervals. Depression (OR range, 1.31-1.42), leaking urine (OR range, 1.25-1.49), stiff/painful joints (OR range, 1.26-1.62), severe tiredness (OR range, 1.29-1.49), osteoporosis (OR range, 1.25-1.52), and hormone replacement therapy (OR range, 0.69-0.79) were associated with falls at two survey intervals. There was no obvious age-related increase or decrease in the number of statistically significant associations. CONCLUSIONS: Identified fall risk factors varied over time, highlighting that falling involves a complex interplay of risk factors in mid-age women.

The relationship between physical activity, and physical performance and psycho-cognitive functioning in older adults living in residential aged care facilities.

OBJECTIVES: Insight into modifiable factors related to falls risk in older adults living in residential aged care facilities (RACFs) is necessary to tailor preventive strategies for this high-risk population. Associations between physical activity (PA), physical performance and psycho-cognitive functioning have been understudied in aged care residents. This study investigated associations between PA, and both physical performance and psycho-cognitive functioning in older adults living in RACFs. DESIGN: Cross-sectional study. METHODS: Forty-four residents aged 85±8years were recruited from four RACFs located in Southeast Queensland. PA was assessed as the average time spent walking in hours/day using activPAL3™. Physical performance tests included balance, gait speed, dual-task ability, reaction time, coordination, grip strength, and leg strength and power. Psycho-cognitive questionnaires included quality of life, balance confidence, fear of falling and cognitive functioning. Associations between PA and each outcome measure were analysed using linear or ordinal regression models. RESULTS: The average time spent walking was 0.5±0.4h/day. Higher levels of PA were significantly associated with better balance (compared with low PA, medium: B=1.6; high: B=1.3) and dual-task ability (OR=7.9 per 0.5h/day increase). No statistically significant associations were found between PA and the other physical and psycho-cognitive measures. CONCLUSIONS: More physically active residents scored higher on balance and dual-task ability, which are key predictors of falls risk. This suggests that physical activity programs targeting balance and dual-task ability could help prevent falls in aged care residents.

Associations between physical activity, medical costs and hospitalisations in older Australian women: Results from the Australian Longitudinal Study on Women's Health.

OBJECTIVES: The aim was to examine the associations between level of physical activity (PA) and non-hospital medical costs, and between physical activity and hospitalisations in older women from 1999 to 2013. DESIGN: Longitudinal observational study. METHODS: Data were collected from participants in the Australian Longitudinal Study on Women's Health, who completed surveys in 1999 (aged 73-78 years), 2002, 2005, 2008 and 2011. Annual cost data (from the Medicare Benefits Schedule) were available for 1999-2013 and hospital admissions data were available for 2002-2010. Costs were expressed in 2013 Australian dollars (AUD). Prospective associations between self-reported physical activity (categorised as inactive, low, moderate or high) and costs/admissions were examined using quantile regression (for costs) and logistic regression fitted with generalised estimating equations (for hospitalisation). RESULTS: Median annual costs were AUD122 (95% confidence interval [CI]=199, 45), AUD284 (CI=363, 204) and AUD316 (CI=385, 247) lower in low, moderate and highly active women, respectively, than in those who were inactive [AUD1890 (interquartile range=1107-3296)]. Odds of hospitalisation were also lower in the low (odds ratio [OR]=0.88, CI=0.80-0.96), moderate (OR=0.77, CI=0.70-0.85) and highly active (OR=0.78, CI=0.71-0.85) women, than in the inactive group. CONCLUSIONS: In inactive older Australian women, a small increase in physical activity may be sufficient to obtain substantial cost savings for the health system and to reduce hospital admissions.

Long-term Effects of Physical Activity Level on Changes in Healthy Body Mass Index Over 12 Years in Young Adult Women.

OBJECTIVES: To examine the effects of overall level and timing of physical activity (PA) on changes from a healthy body mass index (BMI) category over 12 years in young adult women. PATIENTS AND METHODS: Participants in the Australian Longitudinal Study on Women's Health (younger cohort, born 1973-1978) completed surveys between 2000 (age 22-27 years) and 2012 (age 34-39 years). Physical activity was measured in 2000, 2003, 2006, and 2009 and was categorized as very low, low, active, or very active at each survey, and a cumulative PA score for this 9-year period was created. Logistic regression was used to examine relationships between PA accumulated across all surveys (cumulative PA model) and PA at each survey (critical periods PA model), with change in BMI category (from healthy to overweight or healthy to obese) from 2000 to 2012. RESULTS: In women with a healthy BMI in 2000, there were clear dose-response relationships between accumulated PA and transition to overweight (P=.03) and obesity (P<.01) between 2000 and 2012. The critical periods analysis indicated that very active levels of PA at the 2006 survey (when the women were 28-33 years old) and active or very active PA at the 2009 survey (age 31-36 years) were most protective against transitioning to overweight and obesity. CONCLUSION: These findings confirm that maintenance of very high PA levels throughout young adulthood will significantly reduce the risk of becoming overweight or obese. There seems to be a critical period for maintaining high levels of activity at the life stage when many women face competing demands of caring for infants and young children.

Diagnostic accuracy of self-reported arthritis in the general adult population is acceptable.

OBJECTIVE: To summarize the diagnostic accuracy of self-reported osteoarthritis (OA), rheumatoid arthritis (RA), and arthritis (i.e., unspecified) in the general adult population. STUDY DESIGN AND SETTING: A systematic literature search identified studies reporting diagnostic data on self-reported diagnosis of OA, RA, or arthritis in adults in population-based or primary care samples. Index tests included any form of participant-reported presence of the condition. Reference tests included rheumatologist, physician, or health professional examination; medical record review; physician interview; laboratory tests; or radiography. Relevant articles were scored using the QUADAS tool. Diagnostic values were summarized using pooled estimates for sensitivity and specificity. RESULTS: The search strategy identified 16 articles: 11 for OA, 5 for RA, and 4 for arthritis. Four of 16 articles scored high on quality. The pooled sensitivity and specificity were 0.75 [95% confidence interval (CI): 0.56, 0.88] and 0.89 (95% CI: 0.77, 0.95) for OA, 0.88 (95% CI: 0.59, 0.97) and 0.93 (95% CI: 0.66, 0.99) for RA, and 0.71 (95% CI: 0.59, 0.80) and 0.79 (95% CI: 0.65, 0.89) for arthritis. There were not enough studies to conduct meta-analyses for joint-specific OA. CONCLUSION: The accuracy of self-reported OA and RA is acceptable for large-scale studies in which rheumatologist examination is not feasible. More high-quality studies are required to confirm the accuracy of self-reported arthritis and joint-specific OA.

Long-term Consequences of Noninjurious and Injurious Falls on Well-being in Older Women.

BACKGROUND: The physical and mental health consequences of falls are known to influence well-being in the short term. The aim was to investigate the long-term consequences of noninjurious and injurious falls on well-being in older women over 12 years. METHODS: A total of 10,277 participants (aged 73-78 years, 98.8% community-dwelling) returned the 1999 survey of the Australian Longitudinal Study on Women's Health. Follow-up surveys were completed at 3-year intervals. Surveys included questions about falls and related injuries in the past year. Scores on the health-related quality of life Short Form-36 subscales (range 0-100) were used to compare well-being between noninjurious fallers, injurious fallers, and nonfallers using linear mixed modeling with adjustment for confounders. Scores in the years before and after the first fall since enrolment were graphically depicted with time relative to the first fall since enrolment. For this purpose, nonfallers were matched with noninjurious and injurious fallers based on pattern of surveys returned, chronic conditions, and age to assign them a fictitious "time-of-first-fall." RESULTS: Over 12 years, there were 22.5% noninjurious fallers, 30.1% injurious fallers, and 47.5% nonfallers. Compared with nonfallers, noninjurious and injurious fallers scored significantly lower on six and seven of the eight domains at the time of the reported fall, respectively. Significant differences were apparent 12 years before the injurious fall for the subscales role physical, bodily pain, and general health. A drop in scores after the reported injurious fall was seen for role physical, bodily pain, and social functioning. CONCLUSIONS: Among older women, a gap in well-being emerges years before the first reported fall, which may be driven by underlying risk factors rather than the fall itself.

Psychosocial factors associated with increased physical activity in insufficiently active adults with arthritis.

OBJECTIVES: Although physical activity can potentially reduce symptoms of arthritis, 50% of people with arthritis are insufficiently active. The aim was to identify psychosocial factors associated with increased physical activity in mid-age adults with arthritis who did not meet recommended physical activity levels. DESIGN: Longitudinal cohort study. METHODS: Data were from 692 insufficiently active men and women (mean age 55 ± 6.6 years) with arthritis, who answered mailed surveys in 2007 and 2009 in the HABITAT study. Increased physical activity was defined as a change of ≥ 200 MET min/week in walking, moderate and vigorous activities from 2007 to 2009. Scale scores were used to measure psychosocial factors including intention, experiences, attitudes, efficacy, barriers, motivation, social support, and health professional advice. Associations between (1) 2007 psychosocial factors and (2) 2007-2009 improvement (≥ +1 standard deviation) in psychosocial factors and increased physical activity were examined with logistic regression models. Results were adjusted for education, body mass index, and self-rated health. RESULTS: Between 2007 and 2009, 296 participants (42.8%) increased their physical activity. Engagement, mastery and physical activity intention in 2007 were associated with this increase in physical activity (engagement OR = 1.11, 99% confidence interval (CI) = 1.05-1.17; mastery OR = 1.12, 99%CI = 1.02-1.22; physical activity intention OR = 1.29, 99%CI = 1.06-1.56). Improved scores for encouragement (OR = 2.07, CI = 1.07-4.01) and self-efficacy (OR =2 .27, CI = 1.30-3.97) were also significantly associated with increased physical activity. CONCLUSIONS: Positive physical activity experiences and intentions were predictors of increased physical activity among people with arthritis. Improved physical activity confidence and social support were associated with increased physical activity. It is important to consider these psychosocial factors when planning physical activity interventions for people with arthritis.

The effect of dose and type of proton pump inhibitor use on risk of fractures and osteoporosis treatment in older Australian women: A prospective cohort study.

OBJECTIVES: Proton pump inhibitors (PPIs) are among the most prescribed medications worldwide, however, there is growing concern regarding potential negative effects on bone health. The aim was to examine the effect of dose and type of PPI use on subsequent use of osteoporosis medication and fractures in older Australian women. METHODS: Data were included from 4432 participants (born 1921-26) in the 2002 survey of the Australian Longitudinal Study on Women's Health. Medication data were from the national pharmaceutical administrative database (2003-2012, inclusive). Fractures were sourced from linked hospital datasets available for four major States of Australia. Competing risk regression models used PPI exposure as a time-dependent covariate and either time to first osteoporosis medication prescription or fracture as the outcome, with death as a competing risk. RESULTS: Of the 2328 PPI users and 2104 PPI non-users, 827 (36%) and 550 (26%) became users of osteoporosis medication, respectively. PPI use was associated with an increased risk of subsequent use of osteoporosis medication (adjusted sub-hazard ratio [SHR]=1.28; 95% confidence interval [CI]=1.13-1.44) and subsequent fracture (SHR=1.29, CI=1.08-1.55). Analysis with PPI categorized according to defined daily dose (DDD), showed some evidence for a dose-response effect (osteoporosis medication: <400 DDD: SHR=1.23, CI=1.06-1.42 and ≥400 DDD: SHR=1.39, CI=1.17-1.65, compared with non-users; SHRs were in the same range for fractures). Esomeprazole was the most common PPI prescribed (22.9%). Analysis by type of PPI use showed an increased subsequent risk for: (1) use of osteoporosis medication for rabeprazole (SHR=1.51, CI=1.08-2.10) and esomeprazole (SHR=1.48, CI=1.17-1.88); and (2) fractures for rabeprazole (SHR=2.06, CI=1.37-3.10). Users of multiple types of PPI also had increased risks for use of osteoporosis medication and fractures. CONCLUSION: An appropriate benefit/risk assessment should be made when prescribing PPIs, especially for esomeprazole and rabeprazole, as osteoporosis and fracture risks were increased in this cohort of elderly females subsequent to PPI prescription.

Changes in the Relationships Between Body Mass Index and Health Outcomes Across Middle Age and Older Adulthood.

OBJECTIVE: To examine patterns of the incidence of diabetes, hypertension, and mortality by single units of body mass index (BMI) and 5-year age groups using longitudinal data from middle-aged and older women. PATIENTS AND METHODS: Middle-aged (born between 1946 and 1951; N = 13,715) and older (born between 1921 and 1926; N = 12,432) participants in the Australian Longitudinal Study on Women's Health completed surveys in 1996 and at approximately 3-year intervals thereafter until 2011. Proportions of women with diabetes, hypertension, and mortality over 3-year intervals were estimated for each unit of BMI and 5-year age group (45 to < 50, 50 to < 55, 55 to < 60, 70 to < 75, 75 to < 80, and 80 to < 85 years) using generalized additive modeling with adjustment for time-varying covariates. RESULTS: Three-year incidence of diabetes (1.2%-3.6%), hypertension (5.2%-17.8%), and death (0.4%-9.5%) increased with age. For both diabetes and hypertension, the associations with BMI were curvilinear in middle-aged women and became almost linear in older women. With increasing age, the slope became steeper, and the increase started at lower BMI values. For hypertension, there was a marked increase in intercept from 75 years onward. In contrast, mortality risks were highest for low BMI (≤ 20) in all age groups. A clear U-shaped curve was observed only in the oldest age group. CONCLUSION: The shapes of the relationships between BMI and incidence of diabetes, hypertension, and mortality change with age, suggesting that weight management interventions should be tailored for different age groups.